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General NPI Number Information
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NPI Number | 1609507961
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Entity Type | Organization
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Legal Business Name | THWEATT ADVANCED BEHAVIOR ASSOCIATES
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 708 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-1350
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Country | US
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Telephone | 731-614-3101
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Fax | 228-300-2113
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Provider Business Mailing Address
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Address Line | 708 BROAD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-1350
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Country | US
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Telephone | 731-614-3101
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Fax | 228-300-2113
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JACQUELINE RENEE THOMAS THWEATT-BURTON
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Credential | M.ED., BCBA, LBA
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Telephone | 731-614-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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